Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Comment
  • Published:

Management of hypertensive urgencies: a new opportunity for unattended blood pressure measurement

New European Hypertension Society Guidelines for the Management of Hypertension recommend unattended blood pressure measurement use for hypertensive urgencies in the Emergency Wards. Available evidence shows that, in the specific situation of hypertensive urgencies, BP is reduced to less than 160/100 mmHg or even lower values in 30 min in 30% of the patients when unattended BP measurement is used. The implementation of unattended blood pressure measurement could avoid a significant number of antihypertensive treatments.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

References

  1. Mancia G, Kreutz R, Brunström M, Burnier M, Grassi G, Januszewicz A, et al. Authors/Task Force Members:. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens. 2023. https://doi.org/10.1097/HJH.0000000000003480.

  2. Krämer BK, Krämer RM, Benck U, Krüger B. Nonadherence in patients with hypertensive emergency or hypertensive urgency. J Clin Hypertens (Greenwich). 2019;21:64–66.

    Article  PubMed  Google Scholar 

  3. The SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373:2103–16.

    Article  PubMed Central  Google Scholar 

  4. Myers MG, Marshall Godwin M. Automated office blood pressure. Can J Cardiol. 2012;28:341–6.

    Article  PubMed  Google Scholar 

  5. Armstrong D, Matangi M, Brouillard D, Myers MG. Automated office blood pressure—being alone and not location is what matters most. Blood Press Monit. 2015;20:204–8.

    Article  PubMed  Google Scholar 

  6. Agabiti Rosei E. Target blood pressure for treatment: should current recommendations be changed? Hypertension 2016;68(Aug):263–5.

    Article  CAS  PubMed  Google Scholar 

  7. Grassi D, O’Flaherty M, Pellizzari M, Bendersky M, Rodriguez P, Turri D, et al. Hypertensive urgencies in the emergency department: evaluating blood pressure response to rest and to antihypertensive drugs with different profiles. J Clin Hypertens (Greenwich). 2008;10:662–7.

    Article  PubMed  Google Scholar 

  8. Myers MG, Kaczorowski J, Dawes M, Godwin M. Automated office blood pressure measurement in primary care. Can Fam Physician. 2014;60:127–32.

    PubMed  PubMed Central  Google Scholar 

  9. Myers MG, Godwin M, Dawes M, Kiss A, Tobe SW, Grant FC, et al. Conventional versus automated measurement of blood pressure in primary care patients with systolic hypertension: Randomised parallel design controlled trial. BMJ. 2011;342:d286.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Andreadis EA, Agaliotis GD, Angelopoulos ET, Tsakanikas AP, Chaveles IA, Mousoulis GP. Automated office blood pressure and 24-h ambulatory measurements are equally associated with left ventricular mass index. Am J Hypertens. 2011;24:661–6.

    Article  PubMed  Google Scholar 

  11. Kallioinen N, Hill A, Horswill MS, Ward HE, Watson MO. Sources of inaccuracy in the measurement of adult patients’ resting blood pressure in clinical settings: a systematic review. J Hypertens. 2017;35:421–41.

    Article  CAS  PubMed  Google Scholar 

  12. Sega R, Facchetti R, Bombelli M, Cesana G, Corrao G, Grassi G, et al. Prognostic value of ambulatory and home blood pressures compared with office blood pressure in the general population: Follow-up results from the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study. Circulation 2005;111:1777–83.

    Article  PubMed  Google Scholar 

  13. Quinn RR, Hemmelgarn BR, Padwal RS, Myers MG, Cloutier L, Bolli P, et al. The 2010 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 1-blood pressure measurement, diagnosis and assessment of risk. Can J Cardiol. 2010;26:241–8.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Parati G, Ochoa JE, Bilo G, Zanchetti A. SPRINT blood pressure: Sprinting back to smirk’s basal blood pressure? Hypertension. 2017;201:15–9.

    Article  Google Scholar 

  15. Myers MG, Valdivieso M, Kiss A. Use of automated office blood pressure measurement to reduce the white coat response. J Hypertens. 2009;27:280–6.

    Article  CAS  PubMed  Google Scholar 

  16. Myers MG, Godwin M, Dawes M, Kiss A, Tobe SW, Grant FC, et al. Conventional versus automated measurement of blood pressure in primary care patients with systolic hypertension: randomized parallel design controlled trial. BMJ. 2011; https://doi.org/10.1136/bmj.d286.

  17. Myers MG, Valdivieso M, Kiss A. Optimum frequency of automated blood pressure measurements using an automated sphygmomanometer. Blood Press Monit. 2008;13:333–8.

    Article  PubMed  Google Scholar 

  18. Myers MG, Valdivieso M, Kiss A. Consistent relationship between automated office blood pressure recorded in different settings. Blood Press Monit. 2009;14:108–11.

    Article  PubMed  Google Scholar 

  19. Wright JM, Mattu GS, Perry TL Jr, Gelfer ME, Strange KD, Zorn A, et al. Validation of a new algorithm for the BPM-100 electronic oscillometric office blood pressure monitor. Blood Press Monit. 2001;6:161–5.

    Article  CAS  PubMed  Google Scholar 

  20. Chambers LW, Kaczorowski J, O’Reilly S, Ignagni S, Hearps SJC. Comparison of blood pressure measurements using an automated blood pressure device in community pharmacies and family physicians’ offices: a randomized controlled trial. CMAJ Open. 2013;1:E37–E42.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Myers MG. Ambulatory blood pressure monitoring for routine clinical practice. Hypertension. 2005;45:483–4.

    Article  CAS  PubMed  Google Scholar 

  22. Bo Y, Kwok KO, Chu KK, Leung EY, Yu CP, Wong SY, et al. Comparison between automated office blood pressure measurements and manual office blood pressure measurements-implications in individual patients: a systematic review and meta-analysis. Curr Hypertens Rep. 2021;23:4. https://doi.org/10.1007/s11906-020-01118-1.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Kjeldsen SE, Lund-Johansen P, Nilsson P, Mancia G. Unattended blood pressure measurements in the systolic blood pressure intervention trial: implications for entry and achieved blood pressure values compared with other trials. Hypertension 2016;67:808–12.

    Article  CAS  PubMed  Google Scholar 

  24. Myers MG, Kaczorowski J, Paterson JM, Dolovich L, Tu K. Thresholds for diagnosing hypertension based on automated office blood pressure measurements and cardiovascular risk. Hypertension (Dallas, Tex: 1979). 2015;66:489–95.

    Article  CAS  PubMed  Google Scholar 

  25. Myers MG. A short history of automated office blood pressure - 15 years to SPRINT. J Clin Hypertens (Greenwich). 2016;18:721–4.

    Article  PubMed  Google Scholar 

  26. Seo J, Lee CJ, Oh J, Lee SH, Kang SM, Park S. Large discrepancy between unobserved automated office blood pressure and ambulatory blood pressure in a high cardiovascular risk cohort. J Hypertens. 2019;37:42–49.

    Article  CAS  PubMed  Google Scholar 

  27. Vlcek M, Bur A, Woisetschläger C, Herkner H, Laggner AN, Hirschl MM. Association between hypertensive urgencies and subsequent cardiovascular events in patients with hypertension. J Hypertens. 2008;26:657–62.

    Article  CAS  PubMed  Google Scholar 

  28. Webster J, Petrie JC, Jeffers TA, Lovell HG. Accelerated hypertension—pattern of mortality and clinical factors affecting outcome in treated patients. Q J Med. 1993;86:485–93.

    Article  CAS  PubMed  Google Scholar 

  29. Guiga H, Decroux C, Michelet P, Loundou A, Cornand D, Silhol F, et al. Hospital and out-of-hospital mortality in 670 hypertensive emergencies and urgencies. J Clin Hypertens (Greenwich). 2017;19:1137–42.

    Article  PubMed  Google Scholar 

  30. Shin JH, Kim BS, Lyu M, Kim HJ, Lee JH, Park JK, et al. Clinical characteristics and predictors of all-cause mortality in patients with hypertensive urgency at an emergency department. J Clin Med. 2021;10:4314.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Contributions

NRR. Writing. FF: Conceptualization. GG: Supervision, Reviewing and Editing.

Corresponding author

Correspondence to Nicolás Roberto Robles.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Robles, N.R., Fici, F. & Grassi, G. Management of hypertensive urgencies: a new opportunity for unattended blood pressure measurement. J Hum Hypertens 38, 295–297 (2024). https://doi.org/10.1038/s41371-024-00907-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41371-024-00907-4

Search

Quick links